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<meta name="description" content="第五节 RBFDPS的口内试戴1.检查邻接关系2.检查就位情况3.检查动态咬合和静态咬合（可拉出一层纸不可拉出两层）4.检查桥体与软组织的接触关系。5.检查牙合引导（以天然牙为主）第六节 粘接前的考量1.无准确固位装置粘接时易偏转。2.与技师沟通完成后制作定位咬合板。①使用光固化基托材料②制作完成后建议重衬③定位精确并易取出。第七节 粘接前流程1.修复体界面的处理①Zirclean清除试戴后的唾液">
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        <p>第五节 RBFDPS的口内试戴<br>1.检查邻接关系<br>2.检查就位情况<br>3.检查动态咬合和静态咬合（可拉出一层纸不可拉出两层）<br>4.检查桥体与软组织的接触关系。<br>5.检查牙合引导（以天然牙为主）<br>第六节 粘接前的考量<br>1.无准确固位装置粘接时易偏转。<br>2.与技师沟通完成后制作定位咬合板。<br>①使用光固化基托材料<br>②制作完成后建议重衬<br>③定位精确并易取出。<br>第七节 粘接前流程<br>1.修复体界面的处理<br>①Zirclean清除试戴后的唾液污染层<br>②制作树脂半壳<br>③固位翼组织面涂色<br>④1bar压力50μm氧化铝无水喷砂20s<br>⑤99%异丙醇超声水浴3min<br>⑥干燥后涂布Z-prime-Plus反应5min<br>2.预备体界面的处理<br>①上障后基牙酸蚀30s<br>②冲洗磷酸不少于15s<br>③干燥检查白垩<br>④涂粘接剂2遍每遍15s<br>⑤毛刷去掉多余轻吹10s<br>⑥固化20s<br>⑦涂布水门汀定位板就位<br>⑧毛刷清理表面超级牙线清理桥体底部。<br>⑨确定就位后固化20s取下定位板<br>⑩12d刀片清除多余水门汀涂布阻氧剂<br>⑪固化1min后调颌抛光<br>⑫取模制作保护牙合垫。<br>第九部分 夹板式双端RBFDPS的适应症和禁忌症<br>第一节 夹板式RBFDPS的并发症概述<br>1.并发症<br>a.单端脱粘接<br>b.继发龋<br>c.基牙移位<br>2.解决方案<br>a.不可使用暴力拆除<br>b.可分割脱粘接部分<br>c.可变成单端桥使用<br>第二节 适应症分析<br>1.平直型RBFDPS夹板式的受力分析<br>a.几何力学分析扭转力小<br>b.剥脱力小<br>c.水门汀膜受力小<br>d.例如上颌2-2<br>2.弓形RBFDPS夹板式的受力分析<br>a.几何力学分析扭转力大<br>b.剥脱力大<br>c.水门汀膜受力大<br>d.例如上颌2缺失连1,3<br>3.适应症选择<br>a.上颌2,2的缺失连接1,1形成2-2的夹板式桥<br>b.上颌1,1缺失上颌的2,2牙体牙周正常形成2-2的夹板式桥<br>c.平直型牙弓下颌2-2缺失利用3,3形成3-3的夹板式桥<br>d.材料建议选择氧化锆<br>第三节 夹板式RBFDPS禁忌症分析<br>1.基牙松动度大且有2个以上桥体<br>2.侧切牙缺失的修复<br>3.尖牙缺失的修复<br>第十部分：RBFDPS修复尖牙和前磨牙<br>第一节 修复尖牙和前磨牙的现状分析<br>1.修复尖牙和前磨牙的临床报道较少。<br>2.属于尝试的临床治疗方法。<br>第二节 修复尖牙和前磨牙的适应症要求<br>1.解剖条件限制无法实施种植<br>a.缺牙空间不足<br>b.邻牙的牙根向缺失间隙弯曲<br>c.主观不接受种植。<br>2.修复尖牙和前磨牙的要求<br>a.足够的釉质粘接面积<br>b.固位翼和连接体有足够的空间<br>c.健康的牙周条件<br>d.前磨牙连接体满足3×3或3×4mm<br>e.设计单端粘接桥<br>3.对咬合的调整<br>a.修复尖牙时考虑树脂添加前磨牙颊尖做侧导<br>b.修复前磨牙对桥体不参与侧导<br>第十一部分 RBFDPS修复的后期维护<br>第一节：单端RBFDPS复查<br>1.复查时间安排：4-12月<br>2.复查检查的内容<br>a.固位翼的菌斑堆积情况<br>b.基牙早期龋坏情况<br>c.桥体的咬合受力情况<br>d.正畸顾客的保持器佩戴情况<br>第二节：夹板式 RBFDPS 修复后的复查<br>1.复查时认真检查固位翼的脱位及断裂情况<br>2.单侧脱粘接的处理方案：<br>a. 拆分脱粘接的固位翼实现单端粘接<br>b.等待另一侧脱位一起再次粘接<br>c.推荐使用a方案<br>第三节 RBFDPS修复体脱落的处理<br>1.脱落的RBFDPS界面分析：<br>a.修复体和基牙界面都有水门汀（水门汀聚合问题）<br>b.修复体上有基牙没有（粘接时基牙界面污染）<br>c.基牙上有水门汀修复体上没有（粘接时修复体界面污染）<br>2.脱落的RBFDPS再粘固处理<br>1）修复体界面处理<br>a.氧化铝喷砂<br>b.超声荡洗<br>c.涂布ZPP<br>2)基牙界面处理<br>a.氧化铝喷砂<br>b.磷酸酸蚀30s<br>c.涂布粘接剂固化<br>3)树脂水门汀选择<br>a.双固化的树脂水门汀<br>b.加热的树脂<br>第十二部分 RBFDPS修复失败的十个常见原因<br>第一节 连接体或固位翼空间不足<br>1.前牙区连接体3×2mm<br>2.前磨牙连接体3×3-3×4mm<br>3.固位翼空间0.7mm<br>第二节 适应症选择不当<br>1.设计单端的设计成双端<br>2.基牙牙周条件不佳<br>3.咬合处理不正确<br>第三节 选择不合适的水门汀粘接系统<br>1.跟上时代的材料技术革新<br>2.熟悉熟练氧化锆的粘结流程<br>第四节 喷砂后的固位翼粘接面污染<br>1.喷砂提高了氧化锆的组织面的表面活性<br>2.避免氧化锆活化后的界面污染<br>3.喷砂后的氧化锆浸泡与99%的异丙醇溶液中荡洗<br>4.手套不可接触喷砂和荡洗后的氧化锆界面<br>第五节 酸蚀后基牙界面污染<br>1.酸蚀后釉质的界面变化<br>a.酸蚀后表面活性增加<br>b.活性增加易污染<br>2.酸蚀后污染来源<br>a.呼吸的潮气<br>b.龈沟液<br>c.唾液和血液<br>3.避免污染的方法<br>a.排龈<br>b.上障<br>c.排龈+上障<br>第六节 树脂水门汀聚合不佳<br>1.自固化类的水门汀要保持6min不动<br>2.光固化或双固化的时间可控<br>3.建议粘接时使用定位咬合板<br>第七节 基牙粘结面大部分是本质<br>1.釉质粘接面积要达到3×3平方毫米<br>2.制备前可用锡箔纸测量标记<br>3.制备时建议定深后制备<br>第八节 粘接材料使用不当<br>1.科学使用粘接系统<br>a.理解原理<br>b.阅读说明<br>2.注意保质期<br>a.产品保质期<br>b.使用保质期<br>3.正确储存材料<br>a.养成良好使用习惯<br>b.根据说明冰箱保存<br>第九节 脱粘接后再粘接程序不当<br>1.单端粘接桥脱粘接处理<br>2.双端粘接桥脱粘接处理<br>第十节 桥体参与前导或侧导</p>
<p>2019锐读会的课程终于完了，我也完成了全程打卡，一次都没落。坚持到底的人不多啊。继续努力吧。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/039/01.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/039/02.png"></p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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